Which Supplements Work Best for Migraine Prevention?

Finding an abortive and/or preventative treatment that works is often akin to finding the holy grail for those of us with migraine disease. It can be even more difficult for those of us who have limitations on the prescription drugs we can take and/or tolerate. Dietary supplements* may offer an alternative set of treatment options for those of us who have had bad reactions to pharmaceuticals, prefer not to take pharmaceuticals, or have many drug-to-drug interactions that prevent us from taking certain pharmaceuticals.

At the recent Migraine World Summit, Dr. Andrea Harriott, a board-certified neurologist and headache specialist at the John R. Graham Headache Center at Brigham and Women’s Hospital in Boston, offered her insights and recommendations for supplements when it comes to preventing or aborting a migraine attack.

Vitamin B-2

Vitamin B-2 earned a “two thumbs up” from Dr. Harriott, who added that its affordability coupled with its minimal side-effects profile made it a good choice for many. Effective dosing appears to be about 400 mg per day. Certain drugs and foods may decrease or alter the effectiveness of B-2, including alcoholic beverages, tricyclic antidepressants, and contraceptives.

Magnesium

Magnesium also earned a “two thumbs up” from Dr. Harriott, who said it was “probably effective” for migraine treatment. The major issue with this supplement, according to Dr. Harriott, was the potential for diarrhea, especially in patients with migraine disease who already have GI upset (such as those with comorbid IBS). However, alternate methods of delivery, including IV or baths, may reduce GI side effects. Trying a different form of magnesium may also reduce GI side effects. Effective dosing appears to be about 600 mg a day for prevention, and it takes about nine to twelve weeks to work. Unlike many of the other supplements discussed, magnesium also works well as an abortive if given via IV.

Melatonin

According to Dr. Harriott, melatonin is “middle of the road” in terms of efficacy for migraine prevention, though a randomized, double-blind, controlled study from 2016 confirmed the efficacy of melatonin compared to placebo. It also showed melatonin to be as effective and better tolerated than amitriptyline, with many participants experiencing weight loss with melatonin compared to weight gain with amitriptyline. Dr. Harriott did add that patients with migraine disease who also have sleep issues might see the most improvement in migraine attack frequency or severity when treated with melatonin. This is likely due to the relationship between sleep habits and migraine attacks. Effective dosing appears to be 3 mg, preferably in the immediate release form and taken about 30 minutes before bed.

CoQ10

CoQ10 received a “one thumb up” from Dr. Harriott, who said the evidence isn’t as good for CoQ10 as for magnesium and B-2 but it is still “pretty good.” She also said it is well tolerated by most patients. A 2002 open-label trial found a significant reduction in migraine frequency after three months of treatment at 150 mg per day. The Mayo Clinic reports dosing may go up to 300 mg per day for adults, though everyone should always discuss supplements and dosage with their individual doctors.

Vitamin E and/or Vitamin D-3

Both of these vitamins received “two thumbs down” from Dr. Harriott, who noted that they aren’t water soluable and so the body can’t get rid of them as easily as the B vitamins. This makes toxicity a threat and makes them potentially unsafe for long-term use.

Feverfew

Dr. Harriott said there was “some research” to support Feverfew as an effective preventative, but that the research was less than that for CoQ10. She gave it a recommendation of “one thumb up.” A 1998 systemic review of five randomized, placebo-controlled, double-blind trials indicates that feverfew is better than placebo at preventing migraine attacks. The University of Maryland Medical Center says usual dosing is 50 to 100 mg daily, standardized to contain 0.2 to 0.35% parthenolides.

Butterbur

Butterbur isn’t recommended, said Dr. Harriott, despite the fact that it has some of the best evidence for use as a migraine preventative. Unfortunately, it carries “significant safety concerns” as some of the chemicals in it have been linked to cancer and liver damage. “Two thumbs down.”

*Readers are encouraged to remember that we are all individuals and no general recommendation should be taken as medical advice. This means that you should alwaystalk to your doctor before adding any supplement to your migraine treatment protocol or changing your medications in any way. What works for one person or group of people may not work or be safe for you.

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Comments

What works for me to prevent full-blown migraine is Magnesium cream which I apply on my forehead, temple and the back of my neck and shoulders. This cream lessen the intensity of pain as well. It helps me sleep 5 hours at night(I had insomnia, managed onely 1 hr of sleep for a few months last yr). Insuffient sleep has always been my frequent trigger. I haven’t tried oral Magnesium tablet though.

Above all, my greatest saviour is healthy diet according to my blood type. My blood group is B+ and I eat the recommended carbo, proteins, fruits & veg and totally avoid all ‘poison’ food. I am almost migraine free for the past 5 months I am on this diet. It works even better with regular exercises.

I strongly recommend this diet as there’s nothing to lose; after all you are getting the nutrients your body needs.

I’ve heard of the blood-type diet and used it in the past as well, though I hadn’t heard of magnesium cream. Thanks for sharing! I’m glad you’re getting results with lifestyle changes that work for you.

I was regularly taking a triple Magnesium supplement at night, since some of my migraines happened in the morning. I have stopped it though because for various unknown reasons, I was having diarrhea. Truthfully, I still have it but not quite as severe, nine months later. Lots of possible causes but at least now, Magnesium isn’t one of them.

I was prescribed Vitamin D3 for SAD. I am going to check out those side effects. I already knew that Vitamins A, E, and D are fat soluble and will be stored while Vitamin Bs and C are water soluble. One old time doctor called those supplements “making expensive urine” but I know the Vitamin B family has proven themselves. I do take a B-complex daily.

Including Melatonin as a preventative was a surprise. I have been taking it for sleep assistance for quite a while. That, plus a calmer, more orderly life must be why my migraines are less common and less severe (usually).

You may want to ask your doctor about trying a different form of magneisum, if that was helping you. I’ve heard that certain types are better suited for people who experienced diarrhea as they are less likely to cause that side effect. Thank you for commenting!

Butterbur is the only preventive that works for me. I take it along with Propranolol 10 mg. Twice a day. Propranolol had been helpful, but it stopped working as well after about a year. I then added Butterbur 75 mg. Once a day.
The Butterbur I use is said to be free of Pyrrolizidines (sp.) – the substance that causes liver damage.
I have had very few migraines since starting this regimen.

I’m glad you have found something that works for you. I took Propranolol for a while, too, and it seemed to help in some ways but it made my vertigo much, much worse so I had to stop taking it. My neurologist actually mentioned Butterbur to me at my last appointment, but she did stress the necessity of finding a safe brand. Supplements can be tricky since there’s little to no government oversight. I’m glad you’ve found one.